妊娠期糖尿病孕妇分娩前血果糖胺与新生儿糖代谢紊乱的关系。
Associations of Maternal Fructosamine before Delivery in Gestational Diabetes Mellitus Pregnancies with Neonatal Glucometabolic Disorders.
机构信息
Division of Neonatology, Department of Pediatrics, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Department of Perinatology, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
出版信息
J Diabetes Res. 2022 Nov 16;2022:2478250. doi: 10.1155/2022/2478250. eCollection 2022.
BACKGROUND
The offspring of pregnant women with gestational diabetes mellitus (GDM) are vulnerable to be glucometabolic disorders. However, to date, few current studies focused on the associations of maternal accumulated glucose exposure before delivery with neonatal glucometabolic disorders and large for gestational age (LGA) infants. This study is aimed at exploring the associations of maternal fructosamine (FMN) before delivery in GDM pregnant women with neonatal glucometabolic disorders in the first 3 days of life and LGA infants.
METHODS
The study subjects were the GDM pregnant women, who gave birth in our hospital from September 1, 2018 to January 31, 2021, and their newborns. The maternal FMN adjusted by serum albumin (FMN) before delivery was selected as exposure factors. A multivariate logistical regression model was used to calculate the odds ratios (OR) for neonatal glucometabolic disorders, hypoglycemia needing intervention (<2.6 mmol/L), and glucose intolerance (>7.0 mmol/L) in the first 3 days and LGA infants.
RESULTS
In GDM pregnant women, the newborns in the maternal FMN ≥ 75th percentile (≥5.89 mmol/g) group had higher risks in neonatal glucometabolic disorders (aOR 2.50, 95% CI 1.34-4.65, = 0.004) and hypoglycemia (aOR 2.18, 95% CI 1.16-4.10, = 0.016). However, FMN ≥ 75th percentile seemed to be not predictive of the glucose intolerance (aOR 1.76, 95% CI 0.82-3.79, = 0.149) and LGA (aOR 1.56, 95% CI 0.81-3.02, = 0.185). Further, in the sensitivity analysis, the newborns in the maternal FMN ≥ 90th percentile (≥6.40 mmol/g) group also had higher risks in neonatal glucometabolic disorders (aOR 5.70, 95% CI 2.18-14.89, < 0.001) and hypoglycemia (aOR 3.72, 95% CI 1.48-9.31, = 0.005).
CONCLUSIONS
The maternal FMN before delivery in GDM pregnant women was a useful biomarker to identify the offspring with high risk of neonatal glucometabolic disorders. However, the association between maternal FMN and the risk of LGA infants was not so strong.
背景
患有妊娠糖尿病（GDM）的孕妇所生的后代易发生糖代谢紊乱。然而，迄今为止，很少有研究关注母体在分娩前的累积血糖暴露与新生儿糖代谢紊乱和巨大儿（LGA）之间的关系。本研究旨在探讨 GDM 孕妇分娩前血清白蛋白校正的果糖胺（FMN）与新生儿出生后 3 天内糖代谢紊乱和 LGA 婴儿的关系。
方法
本研究的研究对象为 2018 年 9 月 1 日至 2021 年 1 月 31 日在我院分娩的 GDM 孕妇及其新生儿。选择分娩前的母体 FMN 作为暴露因素。采用多变量逻辑回归模型计算新生儿出生后 3 天内糖代谢紊乱（血糖需要干预<2.6mmol/L）、低血糖（<2.6mmol/L）和葡萄糖不耐受（>7.0mmol/L）以及 LGA 婴儿的比值比（OR）。
结果
在 GDM 孕妇中，母体 FMN≥第 75 百分位数（≥5.89mmol/g）组的新生儿发生新生儿糖代谢紊乱的风险较高（OR 2.50，95%CI 1.34-4.65，=0.004）和低血糖（OR 2.18，95%CI 1.16-4.10，=0.016）。然而，FMN≥第 75 百分位数似乎不能预测葡萄糖不耐受（OR 1.76，95%CI 0.82-3.79，=0.149）和 LGA（OR 1.56，95%CI 0.81-3.02，=0.185）。此外，在敏感性分析中，母体 FMN≥第 90 百分位数（≥6.40mmol/g）组的新生儿也有较高的新生儿糖代谢紊乱风险（OR 5.70，95%CI 2.18-14.89，<0.001）和低血糖（OR 3.72，95%CI 1.48-9.31，=0.005）。
结论
GDM 孕妇分娩前的母体 FMN 是一种有用的生物标志物，可用于识别新生儿糖代谢紊乱风险较高的患儿。然而，母体 FMN 与 LGA 婴儿风险之间的关系并不那么强烈。
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